Public Health Policies In Brazil Research Articles

One Health Approach to Leptospirosis: Dogs as Environmental Sentinels for Identification and Monitoring of Human Risk Areas in Southern Brazil.

Leptospirosis has been a neglected, widespread and reemerging zoonotic disease of global importance. The One Health holistic approach combining human, animal and environmental health has been important for control and prevention of zoonotic disease. An urban municipality in Southern Brazil with a high prevalence of leptospirosis was selected by convenience, with asymptomatic human and canine individuals serologically tested using MAT against 30 Leptospira spp. serovars. Epidemiological questionnaires were assessed along with the historical national database, with associated risk factors to dog and human seropositivity analyzed using multiple logistic regression. The spatial distribution of retrospective human leptospirosis cases was analyzed using a Kernel map and overlapped dog seropositivity and historical flooding areas, demonstrating that domestic and asymptomatic dogs may be important environmental sentinels for leptospirosis in such urban areas, even in the absence of human seropositivity and low canine seropositivity. Associated risk factors for leptospirosis in dogs and humans according to multiple regression included healthy dogs (p = 0.02, odds ratio-OR = 0.17, confidence interval of 95%CI 0.03-0.71) with indoor access (p = 0.059, OR = 5.12, 95%CI 1.10-37.7) and human males (p = 0.042, OR = 2.44, 95%CI 1.08-6.11) with presenting calf pain (p = 0.005, OR = 3.14, 95%CI 1.46-7. 14), jaundice (p < 0.001, OR = 4.61, 95%CI 2.11-10.10) and renal failure (p = 0.008, OR = 4.49, 95%CI 1.49-13.76). The greater the rain precipitation (above 3 mm of average annual precipitation), the higher the number of leptospirosis cases in humans. In conclusion, dog active serosurvey and rain precipitation should be systematically reported and plotted altogether as a basis for the early detection and monitoring of human risk areas. Such findings may serve as a basis for public health policies in Brazil and other endemic countries worldwide.

SISTEMA ACGEST PARA ASSISTÊNCIA À SAÚDE DE GESTANTES E PUÉRPERAS NA ATENÇÃO PRIMÁRIA

Ensuring quality prenatal and puerperal care is one of the public health policies in Brazil aimed at women and developed by nurses and community health agents (CHA) in primary care. Technology can improve the work process of these teams by making scheduling, tracking, and reporting easier. The objective was to create an integrated system between the routines of the CHA, the pregnant/postpartum women and the management carried out in the health services for this public. Then, through experimental research, field observations and knowledge of the great need to implement information technology (IT) in the public health environment, AcGest was modeled and developed. For this, IT needs were considered for use by the CHA, pregnant/postpartum women and health units. The system was divided into three modules: two applications for Android smartphones (pregnant and CHA modules) and one for the Web as a management module, which will be used on computers in health units. The system was tested in a simulated environment by the researchers and a health team in the city of Parnamirim-RN. The first version is ready, but it needs to be tested with pregnant/postpartum women, which will only be possible after submission to the ethics committee, for functionality improvements and usability evaluation. The application has great potential to improve routine care for this public, maternal and child health indicators, and serves as a model for further research in the area, as will be seen throughout this article.

Obesity and intersectionality: critical analysis of narratives within public health policies in Brazil (2004-2021)

This study aimed to critically analyze the narrative of Brazilian public health policies in obesity care based on an intersectional approach. This is a qualitative exploratory, documentary, and analytical study based on the "What's the problem represented to be?" approach (WPR). This approach constitutes a methodological instrument for critical analysis of public policies based on six guiding questions. A total of ten documents were selected, published from 2004 to 2021 by the Brazilian government. The critical analysis resulted in three categories: (i) obesity causes and the dominant narrative: what problems are represented?; (ii) dominant narrative and health care: what are the effects for people with obesity?; (iii) obesity and intersectionality: where are silences? The consumption of food and sedentary lifestyle were the dominant narrative as causes of obesity. Intersectionality, mediated by the categories of gender/sex, race/skin-color, and social class, was identified as silenced in the narrative of public health policies, not being associated as linked causes of obesity, nor effectively included in the proposed actions of the policies. The silences found in the study highlight the need to include intersectionality in the elaboration and execution of public health policies and in the care of people with obesity. Considering the intersections of gender/sex, race/skin-color, and social class and their forms of oppression in the emergence and aggravation of obesity, critical analyses of simplistic narratives in public health policies are extremely relevant to problematize gaps affect the care of users with obesity.

Diretrizes nacionais de cuidados em saúde para amputados: desafios atuais e perspectivas

Abstract Estimates from 2022 showed that in the last 5 years, more than 102,000 amputation surgeries were performed by the Sistema Único de Saúde - SUS (Unified Health System, Brazil). An amputation requires adequate rehabilitation process with support network, allowing autonomy and social inclusion. The aim of this paper is to present and discuss the Brazilian Guidelines on Amputee Health Care and other Brazilian public health policies that dialogue with their recommendations. Eight documents were identified that narrow dialogue with the Guidelines: National Health Policy for People with Disabilities, National Health Plan 2012-2015, Guidelines for the Care of People with Chronic Diseases in Health Care Networks and Priority Lines of Care, National Plan for the Rights of Persons with Disabilities - Living Without Limits, Convention on the Rights of Persons with Disabilities, National Health Policy for the Elderly. Brazil has been discussing the need to implement legal mechanisms to ensure full citizenship of people with disabilities. Among the documents presented, the following guidelines were observed in common with the Amputee Health Care Guidelines: providing support and specialized services within the SUS, the need for training of the multidisciplinary team, supply of assistive technology equipment, prevention of injuries and promoting the inclusion of the amputated person. The main challenges and current perspectives involve the articulation of the various levels of health care for this population, and training of the team for comprehensive care for the full rehabilitation of these individuals.

Institutions and the politics of agency in COVID-19 response: Federalism, executive power, and public health policy in Brazil, India, and the U.S.

Abstract The COVID-19 pandemic of 2020 was one of the rare events that shocked almost every world government simultaneously, thus creating an unusual opportunity to understand how political institutions shape policy decisions. There have been many analyses of what governments did. We focus instead on what they could do, focusing on the institutional politics of agency – how institutions empower rather than how they constrain, and how they affect public policy decisions. We examine public health measures in the first wave (March-September 2020) in Brazil, India, and the U.S. to understand how the interplay of institutions in a complex federal context shaped COVID-19 policy-responses. We find similar patterns of concentrated federal executive agency with limited constraints. In each case, when federal leadership failed public health policy responses, federated, subnational states were left to compensate for these inefficiencies without necessary resources.

Infant and Maternal Deaths in Brazil: A 10-Year Analysis of Pregnancy in Adolescence

The aim of this study was to evaluate the epidemiological profile of childhood and maternal-adolescent deaths in Brazil. This is a descriptive, quantitative study, based on data of births and data of infant and maternal deaths of adolescent mothers (aged ten up 19 years old), from the Department of Informatics of the Unified Health System, between 2010 and 2019. The analysis of live-births revealed that most of the adolescent mothers were single, attended for seven or more medical appointments and had a medium level of education of 11 years. Generally, the infants were born on term, from natural childbirth and were non-white. The infant-deaths predominated in the early neonatal period. Maternal deaths prevailed between 15 and 19 years-old, and most of it were from indirect obstetric nature. The decay of the infant mortality rate could not be verified. Maternal mortality rate presented a linear behavior on the studied period. Once teenage pregnancy represent a major challenge for formulators and managers of public health policies in Brazil, the adoption of educational actions is essential to prevent this social and medical issue.

Cooperação governo-academia no Sistema Único de Saúde: uma análise do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica

Abstract This study analyzes the construction of institutional cooperation between the Brazilian Ministry of Health and academic institutions to develop the National Program for Access and Quality Improvement in Primary Care in the Brazilian National Health System (Sistema Único de Saúde - SUS). This qualitative research is based on a case study on this kind of cooperation, which carried out documental analysis and interviews with key actors from the Ministry of Health and academia. The political-institutional context of the federal government and the Ministry of Health in 2011 favored a greater opening to the theme of primary care and health evaluation, and a closeness to academia. This institutional cooperation is the result of a historical process where previous initiatives in the field of public health have connected public and academic managers interested in the development of SUS. This study contributes to the debate about the cooperation between government agencies and academia in implementing public health policies in Brazil.

Analysis of the teaching of homeopathy in pharmacy courses of three High Learning Institutions (IES) in the State of Goiás.

Homeopathy is a medical approach fit to the principles that guide the Brazilian public health policy and agrees with the new paradigm in pharmaceutical education, with the focus on the human condition.Thence the importance of the teaching of homeopathy in pharmacy undergraduate courses. This study aimed to analyze the models for the teaching of homeopathy in three Institutions of Superior Education (IES) in the State of Goiás and to verify its reflection on the level of knowledge on homeopathy expressed by the students. The study programs of the IES were analyzed and questionnaires were applied to students who had already attended homeopathy courses. The results allowed to verify that mistaken ideas on homeopathy were mainly expressed by the students who learned homeopathy as a subtopic of another more general subject. This variability in the models of homeopathy teaching may lead to qualitative diversity in the homeopathic understanding of the pharmacy professionals in the State of Goiás.

A JUDICIALIZAÇÃO DO DIREITO À SAÚDE: COM A PALAVRA O SUPREMO TRIBUNAL FEDERAL

The article aims to analyze the phenomenon of judicialization of the right to health from the perspective of the decisions rendered by Brazilian courts, especially the Federal Supreme Court (STF), in light of the 1988 Federal Constitution (FC) and the rules governing the Unified Health System (SUS). It aims to analyze the effective access of citizens to the fundamental right to health based on the judicial decisions handed down by Brazilian magistrates in the face of the inertia and ineffectiveness of the state entities responsible for implementing public health policy, without disregarding the division of administrative powers described in the Federal Constitution and in infra-constitutional norms. It also intends to provide an analysis of the phenomenon of judicialization of the right to health and the decisions handed down by the Supreme Court to conclude that these are not obstacles to the effectiveness of public health policy in Brazil. The research was built based on the finding of the need for clarification of the phenomenon (qualitative method). As for the methodology, the study was developed by means of bibliographic and documental research, so that, during the course of this work, case studies related to the decisions handed down by the Supreme Federal Court were carried out based on the specialized literature review. Using the deductive method, it is possible to understand how the effective action of the Judiciary has provided citizens with access to health care, without hindering the implementation of other public policies by the state entities or violating the division of competencies described in the Federal Constitution.

Risk of initiation to smoking with the use of electronic cigarettes: systematic review and meta-analysis

This article aims to evaluate the association between the use of electronic cigarettes and initiation to smoking, through a systematic review with meta-analysis of longitudinal studies. A bibliographic search was performed on the MEDLINE, Embase, LILACS and PsycInfo databases. Reference selection, data extraction and risk of bias assessment of the studies were independently carried out in pairs, and the disagreements were discussed with a third researcher to reach a consensus. Meta-analysis was performed using the Mantel-Haenszel random effects model. Among the 25 studies included, 22 evaluated the outcome of conventional cigarette experimentation and nine assessed the outcome of current smoking (in the last 30 days). The meta-analysis showed that the use of electronic cigarettes increased the risk of conventional cigarette experimentation by almost three and a half times (RR=3.42; 95%CI 2.81-4.15), and by more than four times the risk of current smoking (RR=4.32; 95%CI 3.13-5.94). The risk of smoking initiation is significantly higher among electronic cigarette users. The marketing authorization of such devices may represent a threat to public health policies in Brazil.

Neo-Traditional Medicines: Ethnographic Contributions to Conceptual Definition.

Since the end of 1970, the World Health Organization has encouraged the development of public policies that expand the approach to care and the therapeutic possibilities offered by its member states beyond technoscientific health care. In Brazil, the institutionalization of this approach is related to the promotion of popular and traditional knowledge associated with the usage of medicinal plants. With this convergence as an argumentative horizon, in this ethnography we examine the institutionalization of pharmaceutical services that have become known in Brazilian public health policy as living pharmacies. This term has been mobilized throughout the history of phytotherapy in Brazil and refers to the possibility of instituting the use of medications that expand care approaches and problem resolution possibilities beyond the domain of the biomedical sciences, evoking alliances with so-called traditional and popular knowledge and practices. For this, we propose and discuss the concept of neo-traditional medicines as a comprehensive-interpretative category, verifying the approximation and distancing points assigned to it in contemporaneous anthropological literature. Beyond the domain of science over other fields of knowledge, we argue in favour of this category in order to present new arrangements and social dynamics that define Brazil's medication policies.

A POLÍTICA PÚBLICA DE SAÚDE E OS MIGRANTES: DESAFIOS DA EDUCAÇÃO EM SAÚDE

The article analyzes the role of Health Education in migratory contexts. Initially, there is a thought about health rights and migrants, which during their mobility process go through aggravated lack of this right. Then, it is presented an approach of the Brazilian Public Health Policy towards migrants, considering today as the new users of the health system and finally, the fundamental importance of Health Education within the Public Health Policy is analyzed as an instrument for the promotion and prevention of migrants' health. The method adopted presents a predominantly bibliographic analysis.

Spatial\u2013temporal pattern of cutaneous leishmaniasis in Brazil

BackgroundCutaneous leishmaniasis (CL) is a vector-borne disease classified by the World Health Organization as one of the most neglected tropical diseases. Brazil has the highest incidence of CL in America and is one of the ten countries in the world with the highest number of cases. Understanding the spatiotemporal dynamics of CL is essential to provide guidelines for public health policies in Brazil. In the present study we used a spatial and temporal statistical approach to evaluate the dynamics of CL in Brazil.MethodsWe used data of cutaneous leishmaniasis cases provided by the Ministry of Health of Brazil from 2001 to 2017. We calculated incidence rates and used the Mann–Kendall trend test to evaluate the temporal trend of CL in each municipality. In addition, we used Kuldorff scan method to identify spatiotemporal clusters and emerging hotspots test to evaluate hotspot areas and their temporal trends.ResultsWe found a general decrease in the number of CL cases in Brazil (from 15.3 to 8.4 cases per 100 000 habitants), although 3.2% of municipalities still have an increasing tendency of CL incidence and 72.5% showed no tendency at all. The scan analysis identified a primary cluster in northern and central regions and 21 secondary clusters located mainly in south and southeast regions. The emerging hotspots analysis detected a high spatial and temporal variability of hotspots inside the main cluster area, diminishing hotspots in eastern Amazon and permanent, emerging, and new hotspots in the states of Amapá and parts of Pará, Roraima, Acre and Mato Grosso. The central coast the state of Bahia is one of the most critical areas due to the detection of a cluster of the highest rank in a secondary cluster, and because it is the only area identified as an intensifying hotspot.ConclusionsUsing a combination of statistical methods we were able to detect areas of higher incidence of CL and understand how it changed over time. We suggest that these areas, especially those identified as permanent, new, emerging and intensifying hotspots, should be targeted for future research, surveillance, and implementation of vector control measures.Graphic abstract

A Critical Review of Obesity in Healthcare Systems in Brazil and Portugal: Pathways, Guidelines and Strategies

Background: Obesity and its associated diseases in the 21st century has led to new public policies with international commitments. Objective: The objective of this review was to examine public initiatives and policies to tackle obesity in Brazil and Portugal over the past two decades, identifying frameworks, guidelines and strategic actions. Methods: Official documents Brazilian and Portuguese public health policies were analyzed for international guidelines from 1999 to 2019. The documents were organized and analyzed by date. Additionally, they were evaluated for frameworks and actions proposed for individuals, communities, and the population across all levels of healthcare. Conclusion: This study shows that Portugal and Brazil have taken different paths when it comes to the creation and implementation of their strategies to manage obesity. In Brazil, actions aimed at promoting healthy eating have been introduced to children and are implemented by many government agencies. Portugal, on the other hand, has provided greater access to individualized healthcare services and has involved different sectors in addressing these issues.

Princípio da integralidade e as redes de atenção à saúde em micro território catarinense

A reflexão deste estudo trata da política pública de saúde brasileira pelas intervenções de forma regionalizada e promoção da saúde, tendo como princípio a integralidade, por meio de composição de redes de atenção à saúde, em microterritório catarinense. Justifica-se os conhecimentos apresentados diante do intenso processo de consolidação do SUS, ao se destacar o estágio que o processo da regionalização e das redes avançou diante das diretrizes e intervenções na regional de saúde de Mafra. O objetivo abordou aspectos referentes à questão da regionalização e nela as redes, com análise acerca do que se pôde perceber sobre os contratempos e avanços na regional de saúde de Mafra, no qual se vivenciou um processo de organização e implementação de redes em saúde intra e inter território, uma vez que a política de gestão do governo catarinense se anunciava regionalizado e preocupado com o fortalecimento das estruturas locais e regional, nas várias frentes preconizadas pelas políticas públicas não apenas na saúde. O Estado deveria ser o coordenador desse processo, porém, no microterritório da regional de saúde de Mafra os desencontros, as mudanças de gestão e de gestores atrasaram esse processo. Conclui-se que falta de empenho na disseminação do conhecimento como compromisso moral do governo brasileiro pela saúde pública, assegurado constitucionalmente, se perde pela incompreensão desta sua atribuição e o acúmulo de experiências que subsidiaram a caminhada na implantação da saúde pública, na implementação das redes de atenção, que se perdem com essas mudanças. Palavras-chave: Redes de atenção à saúde. Integralidade. Promoção da saúde. SUS.

A real-life study of the positive response to DAA-based therapies for hepatitis C in Brazil

A retrospective cohort of 11,308 chronic hepatitis C infected patients treated with regimens that included Sofosbuvir (SOF), Daclatasvir (DCV), Simeprevir (SMV), or an association of Ombitasvir, Veruprevir/Ritonavir and Dasabuvir (3D) with or without Ribavirin (RBV) were assessed for sustained virologic response (SVR) or viral cure after a 12-week treatment. Logistic regression analyses were used to identify factors independently associated with positive response to direct-acting antivirals (DAA)-based therapies.Overall 57.1% were male; 48.3% self-identified as white; 78.3% were over 50 years old; 44.1% were from the Southeast region; 47.7% had genotype 1b; and 84.5% were treated for 12 weeks. The SVR rates with DAAs ranged from 87% to 100%. Genotypes 1 and 4 had higher SVR rates (96.3–100%), and genotypes 2 and 3 had SVR of 90.6–92.2%, respectively. Treatment durations of 12 and 24 weeks were associated with an average SVR of 95.0% and 95.9%, respectively. Females were half as likely (OR 0.5; 95% CI 0.4−0.6) to have a negative response to therapy compared to males, and those with genotypes 2 and 3 were one and half fold more likely (OR 1.5–2.2; 95 CI% 0.7–2.9; 1.2–3.6 and OR 2.7–2.8; 95% CI 2.0–3.8, respectively) to not have SVR compared to genotype 1. Patients in the age-range of 50–69 years old were 1.2-fold (OR 1.2; 95% CI 0.7–1.9) more likely to not have SVR compared to other age groups, although not statistically significant.This study is the first of this magnitude to be held in a Latin-American country with high SVR results, supported by a free-of-charge universal and public health system. The high performance found in this study gives support to the Brazilian public health policy decision of adopting DAA-based therapies as a strategy to eliminate HCV by 2030.

Judicialization of Health in Brazil: Categorization of decision-making stages by the Supreme Federal Court and the impacts on the Unified Health System

This article intends to analyze the decision-making stages of the judicialization of public health policy in Brazil by the highest legal court in the country — the Supreme Federal Court of Justice (STF). Subsequently, we present the most relevant criticisms of the excessive judicialization of health, attempting, to list alternatives in order to discuss a possible program of improvements for public health policy, having as its main element the dialogue between the Brazilian Justice and Health Systems. The methodology used can be characterized as quali-quantitative, considering that data collection was used on the STF website for research and analysis of judicial decisions, as well as a biographically doctrinaire review.

Public Policies for making the right to life effective: The problem of suicide at ‘Third Bridge'

Abstract The World Health Organization (WHO) recognizes suicide as a public health priority. According to the same, between 2010 and 2016 the suicide rate in Brazil increased about 7%, in contrast to the world index, wich fell 9,8%. In the state of Espírito Santo - ES (estimated population of 4 million people), the number of suicide events reached 233 in 2018, the highest rate ever recorded by Datasus Mortality Monitoring Panel to the state. Suicides on public venues are noteworthy. According to data from the Rodovia do Sol Concessionaire (Rodosol), in 2018 about 41% of suicides in this state occured in metropolitan region of Vitória (estimated population of 2 million people). In Deputado Darcy Castello de Mendonça bridge, popularly known as Third Bridge, 71 attemps were counted, of wich 7 culminated in suicide. As a point of concern, this bridge, main link between the cities of Vitória and Vila Velha, has a contingency plan for emergency and crisis situations since 2016, in addition to cameras monitored by a prepared team that work together with a firefighter's team allocated near the bridge to intervene at any time of the day. The monitoring of the situation makes it possible to verify that, since 1999, the suicides that have occurred add up to lower rates in relation to the attempts. However, there was an increase of approximately 44% in the number of people who attempted suicide in the period from 2015 to 2018. Knowing that interventions to prevent suicide include reducing access to lethal means, it stands out that in 2019 a plan to build a protection net in Third Bridge was approved by the government. These strategies, combined to provided health care from the State Hospital of Clinical Attention and suicide preventive measures from public healthcare system SUS, are in accordance with Brazilian's public health policies. It is a recognition, by the state, that the life of the individual has a public significance, and should be protected even from the individual itself. Key messages Interventions to prevent suicide must include reducing access to lethal means, that is knowingly a highly effective preventive practice and is responsibility of public policies of a country/state. Knowing that life has a public and political dimension, the suicide barrier implementation is necessary for the State to fulfill its duty to protect the life of the citizen.

Attention to the Crisis in mental health: centralization and decentralization of practices

This article focuses on the attention to the crisis in mental health within the scope of Brazilian public health policies. It sets out to show the theoretical and practical disputes of significance about the notions of crisis that unfold in different models of care in situations of urgency and emergency in mental health, as well as in challenges to the effectiveness of the care process in the health network. The survey began with a descriptive and exploratory study, with emphasis on the study of protocols and institutional documents in mental health, from the sociotechnical standpoint. As an original contribution of this article, the main socio-technical dichotomies that emerged from the processes of attention to the crisis in Brazil (in the use of terminologies, clinical practice and attention models, the main challenges for consolidation of network care and in the vacancy regulation strategies) were highlighted.

CÂNCER GINECOLÓGICO E SUAS POLÍTICAS PÚBLICAS SOB A PERSPECTIVA DE PEPLAU

When paralleling the Interpersonal Theory with public health policies in Brazil and the assistance to women in health promotion, prevention or treatment of gynecological cancer, it is reflected that gynecological cancer in women is seen by the woman herself as a part of your self, is your femininity, your identity; concepts which are deeply crushed by the news of a cancer diagnosis. In view of the exchange of experiences at the time of assistance, Peplau states that the assistance and the relationship of those involved are influenced by the external environment (environment), internal environment (personality, lived experiences, religion, culture) and the professional's posture. In this scenario of a fragile and frightened woman, often without due privacy or attention due to the lack of inputs, structure and high demand from the public health service in Brazil, her assistance can be compromised, precisely because she does not have interpersonal skills, either in promotion health, prevention or treatment. It can be said that information is a precious asset when it comes to health care. In addition to the correct information, the nursing professional and the others who form the multidisciplinary team need to have an empathetic, humanized, welcoming attitude, based on science, ethics and respect for the woman's life, in order to pass the correct information in the correct way for greater adherence. Given “golden assistance”, it is only possible based on public training policies for its employees, which certainly not only update and train professionals, they save lives.